Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) Job satisfaction among senior doctors generally high
(2) Bad role models lead junior doctors to regret choice of career
(3) Most patients take less than two minutes to tell their story
What is a good doctor and how do you make one? asks this
week's special issue of the BMJ. The idea for the issue came
from a recent poll of BMJ readers and has prompted a debate
about the sort of doctors society wants and expects.
Topics include the importance of role models in making good
doctors, how to measure "goodness" in individuals and
healthcare systems, and patients' views of the good doctor.
Guardian columnist Poly Toynbee asks whether the new
edition of Tomorrow's Doctors is an idealistic or practical
standard to be set for new doctors.
Comedian and writer Arthur Smith gives us his 15 rules for
doctors, while psychoanalyst Jeremy Holmes suggests that the
search for a good doctor is an illusion.
(1) Job satisfaction among senior doctors generally high
( UK senior doctors' career destinations, job satisfaction, and
future intentions: questionnaire survey )
http://bmj.com/cgi/content/full/325/7366/685
Levels of job satisfaction among senior doctors have been
generally high, but many do not plan to work to the age of 65,
finds a study in this week's BMJ.
All traceable 1974 UK medical school graduates were sent
questionnaires about their employment history, current job
satisfaction, and plans for the future. Some 97% of those who
responded were in medical employment and 85% worked in
the NHS.
Overall, job satisfaction was rated reasonably highly, but there
were significant differences between occupational groups, with
hospital doctors reporting greater satisfaction than GPs.
Among GPs, women were more satisfied than men and
part-timers were more satisfied than those working full-time.
86% of NHS hospital doctors and 78% of GPs said they
definitely intended to continue working for at least another five
years. Reasons given for considering leaving medicine included
disillusionment with the NHS, work-related stress, and the
desire to work in a developing country.
The results demonstrate the extent to which the medical
workforce has changed. In 1974 only a quarter of graduates
were female and women were less likely than men to become
consultants. The majority of medical school entrants are now
female and in the future many more senior posts will be filled
by women.
The study concludes that senior doctors have been committed
to the NHS and generally satisfied with their work.
Nevertheless, many of the respondents commented that their
work was close to the limit of what they considered
acceptable, and said that they would retire before the age of
65.
Contact:
Dr Michael Goldacre, Department of Public Health,
University of Oxford, Oxford, UK
Email: michael.goldacre@dphpc.ox.ac.uk
(2) Bad role models lead junior doctors to regret choice of career
( How important are role models in making good doctors? )
http://bmj.com/cgi/content/full/325/7366/707
Bad role models can lead junior doctors to regret their choice
of career, finds a study in this week's BMJ.
The majority of consultants in the UK act as supervisors for
junior doctors. They are entrusted with the educational
supervision of doctors in their first year of practice and are
responsible for inculcating the principles of good medical
practice.
Researchers from the University of London conducted a
confidential survey of preregistration house officers across the
UK. Respondents were asked to describe an exchange with a
supervising consultant that had seemed important or interesting
and to tell the researchers how they felt about it.
In 59 per cent of cases the described exchange was positive,
with the house officer being praised, taught, given career
advice, support or offered examples of excellent patient care.
In these cases the house officers admired and respected their
consultants, they were likely to feel happy in their choice of
medicine as a career and to believe they would make good
doctors.
Over 20 per cent of house officers described a consultant
behaving badly towards them by making unreasonable
demands, bullying, being unfair, or being sexist. In a further 7
per cent of cases the consultant was portrayed as
incompetent, insensitive or negligent towards patients. These
house officers lacked respect for their consultant and were
most likely to regret their choice of medicine as a career.
A healthy mentoring relationship is likely to provide the mental
and moral challenges essential to continuing self improvement.
However some senior doctors have a poor attitude towards
educational supervision, causing confusion, distress and anger
in doctors under their supervision.
The researchers conclude that role models may not be a
dependable way to impart professional values, attitudes and
behaviours and suggest these attributes should be explicitly
taught through peer group discussion and by trained mentors.
Contact:
Dr Shelley Heard, Postgraduate Dean, London Postgraduate
Medical and Dental Education, University of London,
London, UK
Email: sheard@londondeanery.ac.uk
(3) Most patients take less than two minutes to tell their story
( Spontaneous talking time at start of consultation in outpatient
clinic: cohort study )
http://bmj.com/cgi/content/full/325/7366/682
Doctors should let patients talk without interruption at the start
of a consultation, a study in this week's BMJ suggests.
Research in America has shown that doctors take the lead in a
consultation on average after 22 seconds, probably because
they believe it would be time-consuming to allow patients to
talk uninterrupted. Doctors in Switzerland set out to test this
assumption.
Patients at an outpatient clinic in Basle were asked to talk
spontaneously about their complaints and indicate when they
had finished. Their doctors were instructed to time them on a
hidden stopwatch and not to interrupt until the patient said
"What do you think, doctor?"
The average spontaneous talking time was 92 seconds and
78% of patients had finished within two minutes. Sex and
social status did not influence the results, but older patients
tended to talk for longer.
In all cases the doctors believed that their patients were
providing important information and did not feel the need to
interrupt them.
The authors conclude that doctors do not risk drowning in
their patients' complaints if they let them talk spontaneously.
Even in a busy practice doctors should be able to listen for
two minutes, which will be sufficient for most patients.
Furthermore, the data was gathered in a referral centre
characterised by patients with complex problems. Patients in
other groups may need even less time to tell their story.
Contact:
Dr Wolf Langewitz, Executive Director, Department of
Internal Medicine, University Hospital,
Basle, Switzerland
Email: wlangewitz@uhbs.ch
( Letters: various authors )
http://bmj.com/cgi/content/full/325/7366/711
A good doctor should be compassionate, understanding,
honest and empathetic reveals a poll carried out in this week's
BMJ.
Over 100 people from 24 countries responded to two
questions posted on the BMJ website (bmj.com): 'what makes
a good doctor?' and 'how can we make one?'
In response to the first question 70 qualities were listed
including compassion, understanding, honesty, humanity,
competence, commitment, empathy, respect, creativity and a
sense of justice. In addition a number of common themes
emerged. Firstly, there was a consensus that there are plenty
of good doctors and they should be nurtured. Secondly a
good doctor, is first and foremost, a good human being.
Thirdly, a good doctor is someone who likes people and
genuinely wants to help them. Finally, the majority of
respondents concluded that good doctors are special in some
way, and will make an extra effort to care for their patients.
Making a good doctor seemed a greater challenge than
defining one. However there was a general consensus that
healthcare systems across the world were failing to produce
good doctors.
A number of respondents felt that 'bad' doctors were a
product of a society that undervalues doctors. The response of
one first year intern from Israel echoed the thoughts of several
others: "Our society undervalues doctors yet expects and will
accept nothing short of perfection? Even with perfect risk
management mistakes will be 'made'?people will die young or
decline with age, and not all pregnancies will have a good
outcome. Unfortunately doctors are more easily sued than
God, and moreover?pay cash."
To read the debate in full log on to http://ww.bmj.com/gooddoctor
Contact:
Dr Alexander Vass, BMJ, British Medical Association,
BMA House, London, UK
Email: avass@bmj.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)